Modern surgical treatment of malignant skin melanoma: A brief literature overview

BackgroundMalignant melanoma (MM) of the skin is a rare, highly malignant tumour, affecting younger age. Its incidence rate has been rising as compared to all malignant neoplasms – 5 per cent of all newly diagnosed cancers in men, and 6 per cent of those in women.AimsThe aim of the literature review is the present the contemporary tendencies in the surgical treatment and monitoring of patients with malignant melanoma of the skin.Methods Systematic Literature Review Made By Google and Science Direct.com Search Engines. Publications and guidelines in English, including the newest aspects in the overall care of patients with malignant melanoma of the skin. Information for the indications and contraindications of performing a sentinel biopsy.Results The study established that the most modern surgical treatment of a malignant melanoma of the skin includes: primary tumour biopsy, sentinel biopsy of the regional lymph nodes with wide re-excision of the affected area, usually with a radius of 2cm, and the removal of local recurrences, lymph and distant organ metastases. When it comes to monitoring, it has to be done according to the contemporary worldwide guidelines.ConclusionSuccessful treatment of skin MM is in direct correlation to keeping up with the most modern tendencies

A rare clinical case of synchronous colorectal cancer, affecting the transverse colon

Synchronous colorectal cancer is a rare condition, which presents with the simultaneous development of more than one primary carcinoma and affects different segments of the colon and rectum. The incidence of this disease is about 3.5 per cent of all carcinomas of the colon and rectum and more often affected men. Adenocarcinoma is the most common histological type for synchronous colorectal cancer.We present a rare clinical case of a 62-year-old woman with synchronous colorectal carcinoma, located in the transverse and sigmoid colon and verified histologically by colonoscopy

Primary, nodal, marginal zone lymphoma of a woman’s left breast imitated fibroadenoma

BackgroundPrimary breast lymphoma is a rare malignant neoplastic disease, accounting for around 0.5 per cent of all malignant diseases of that organ, and also 2.2 per cent of extranodal lymphomas. The most common histopathological types are: diffuse large B-cell lymphoma, extranodal B-cell marginal zone lymphoma and MALT lymphoma. The primary affected group is with median age between 55 and 62 years. The clinical manifestation is usually of a tumour process in the affected breast.Case presentationHere we present an extremely rare case of a 68 years old woman with primary, nodal, B-cell, marginal zone lymphoma of the left breast, presenting itself under the mask of a benign tumour process, found accidentally following a histopathological examination of excisional samples.ConclusionsPrimary, nodal, marginal zone, B-cell lymphoma of the breast is extremely rare. Its clinical and mammographic presentation completely overlaps with those of fibroadenoma, which makes diagnosing it preoperatively practically impossible. Main treatment method here is not surgical, but radiological and chemotherapeutic

Diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography over conventional imaging studies to detect malignant lesions in staging and restaging after radically treated primary and recurrent locoregional cutaneous melanoma

Introduction. Cutaneous melanoma (CM) has a high metastasizing potential and requires many imaging tests for accurate staging and restaging. As a hybrid imaging method, 18F-FDG PET/CT has the power to diagnose clinically undetected regional and distant metastatic disease with a better detection rate than conventional imaging. The aim of our study was to assess the value of 18F-FDG PET/CT in detecting different types of malignant lesions – local recurrences, regional lymph nodes (RLN), in-transit (ITM) and distant metastases (DM) after radical excision of the primary lesion or regional recurrence.  Materials and methods. A retrospective analysis was performed of all patients with CM referred for 18F-FDG PET/CT for staging or after resection of locoregional recurrent disease. All patients had a combination of pre-PET/CT conventional imaging studies (CIS), including a whole body computed tomography (CT) and ultrasonography (US) of the RLN basin/s. The results from 18F-FDG PET/CT were compared with the CIS results.  Results. 246 consecutive patients, aged 10-87 years were included with identification of 71 malignant lymph nodes, 4 local recurrences, 28 ITM, and 65 DM in total. The detection rate of 18F-FDG PET/CT for RLN was 84.5%, and in the diagnosis of ITM and DM, it reached a sensitivity of 100.0% with 0.7% of false positive results.  Conclusions. 18F-FDG PET/CT has an invaluable role in the detection of small, clinically silent ITM and DM and has a smaller value in RLN detection. It may guide the process of selection of suspicious lesions, suitable for biopsy or further ultrasound follow-up

Amelanotic melanoma of the skin – detailed review of the problem

BackgroundMalignant melanoma (MM) of the skin accounts for about one per cent of all malignancies in humans. Amelanotic melanoma is a rare tumour, diagnosed in eight per cent of all melanomas.AimsThe study aimed to analyse our clinical experience with amelanotic MM of the skin and the statistical data from a retrospective five year analysis of pigmented and amelanotic types of skin melanoma. Furthermore, we compare our results to those from other teams' studies. To reach the corresponding in-depth conclusions.MethodsThe study included 151 patients with malignant melanoma of the skin, diagnosed and treated at Dr. Georgi Stranski University in Pleven, Bulgaria, between 2012 and 2016. All the patients signed informed consent forms.ResultsOf the 151 patients we studied, 14 (9.3 per cent) were diagnosed with amelanotic melanoma. The average Breslow thickness in patients with amelanotic MM was 4.2mm, while in pigmented MM patients it 2.1mm. Local recurrence rates (35.7 per cent) were higher in patients with amelanotic melanoma. Distant metastases were found in 39 of all tested patients with melanoma. Of the 14 patients with amelanotic MM, eight had such metastases.ConclusionAmelanotic melanoma was diagnosed too late. Local recurrences were six times as many as the ones diagnosed in pigment melanoma. Distant metastases were twice as many, and mortality rates were three times higher

Lymph node involvement and the role of lymphadenectomy in patients with advanced ovarian cancer

BackgroundOvarian carcinoma (OC) is one of the most common types of cancer diagnosed in women and its clinical significance is reflected in the leading place it holds in the morbidity and mortality rates among women diagnosed with cancer. The evaluation of lymph node involvement by the oncosurgeons is a pivotal step towards proper disease staging and adjuvant therapeutic choices, towards optimal treatment outcomes.AimsThe aim of this study was to investigate the lymph node metastases and patient characteristics in women with advanced OC (FIGO II-IV).MethodsThe study includes 58 patients with advanced OC (FIGO II-IV) operate in our clinic for the period 2004-2012. The patients were analysed with respect to age, FIGO stage, histological type and tumour grading, type of surgical verification of lymph nodes (biopsy, pelvic and/or para- aortic lymphadenectomy), results from histopathological reports describing the extent of lymphatic involvement, localization of lymph node metastases, and presence of ascites.ResultsLymph node metastases were found in 56.7 per cent of the patients. 24.1 per cent of the patients had micrometastases in lymph nodes that were not initially detected on both pre- operative diagnostic imaging and intraoperative inspection. ConclusionThe only reliable method for initial/early detection of lymphatic metastases in patients with OC is the surgical, through lymphadenectomy, with subsequent histological evaluation

Contemporary challenges of warty carcinoma of cervix - Our experience and review of literature

BackgroundWarty carcinoma of the cervix is a rare subtype of squamous cell carcinoma. In general, it is not as aggressive as the other subtypes, and has a better prognosis.AimsThe aim of this study was to investigate overall and recurrence-free survival rate in patients with Warty carcinoma of the cervix.MethodsDuring the ten year period (2008–2017) in the Clinic of Gynaecologic oncology at the UMHAT - Pleven, Bulgaria were operated 714 cases with cervical cancer, 14 of which were histologically confirmed as a Warty carcinoma. Patients were investigated by retro- and prospective analysis for overall and recurrence-free survival rate.ResultsWarty carcinoma accounts for 1.94 per cent of all cervical carcinomas, operated in the clinic. The mean age of the patients was 48 years, ranging from 29–72 years. According to the FIGO staging systems for cervix, patients were staged as follows: in stage IB1 – 43 per cent and in stage IB2 – 57 per cent. Despite the high percentage of locally advanced process, only in one case out of all the patients there was local spreading of the lesion towards the uterine cavity and in one case there were metastases in the pelvic lymph nodes. Lymphovascular space invasion was not seen in any patient, and neither were perineural or perivascular invasion.ConclusionThis report highlights a favourable course and good prognosis of Warty carcinoma of the cervix. It is necessary to reconsider the aggressive surgical treatment and subsequent chemotherapy in women with Warty carcinoma of the cervix

Isthmocele: An important sequelae of caesarean section - report of three cases and mini review

An isthmocele appears as a fluid-filled pouch-like defect in the anterior uterine wall at the site of a prior caesarean section, and ranges in prevalence from 19 per cent to 84 per cent, a direct relation to the increase in caesarean sections performed worldwide. It is the result of incomplete healing of the isthmic myometrium after a low transverse uterine incision performed for caesarean section. Although mostly asymptomatic, it may cause menstrual abnormalities, chronic pelvic pain, and secondary infertility. Scar tissue dehiscence, scar pregnancy, and abnormally adherent placenta are some of the obstetric complications associated with this defect. Diagnosis of the defects can be made with transvaginal ultrasound (TVUS), saline infused sonohysterogram (SIS), hysterosalpingogram, hysteroscopy, and magnetic resonance imaging (MRI). Surgical treatment of an isthmocele is still a controversial issue but it should be offered to symptomatic women or asymptomatic patient who desires future pregnancy. When surgery is the treatment choice, laparoscopy guided by hysteroscopy, or hysteroscopy alone are the best options depending on the isthmocele's characteristics and surgeon expertise.We would like to present a mini-review of the topic with contribution of three cases

Basaloid squamous cell carcinoma of uterine cervix in a young adult - A case report

Basaloid squamous cell carcinoma of the uterine cervix is an extremely rare and aggressive malignancy. It has poorer clinical outcomes than squamous cell carcinoma of the uterine cervix. The tumour has specific microscopic features, and usually affects patients in their late 60s and 70s. We present a very rare case of a 30-year-old woman, who was diagnosed on a prophylactic examination and was treated with radical hysterectomy and pelvic lymph node dissection. The follow-up of the patient is ongoing

Definitive treatment of a basal cell carcinoma on the upper lip through the oral administration of Vismodegib

Basal cell carcinoma is the most common malignant neoplasm of the skin of the face in old, caucasian humans. The tumour growth slow and rarely has metastases. The clinical presentation is different. The main method for treating is radical surgical excision, but if the tumour is very big or there are metastases, there is a very effective target therapy with the peroral capsules Vismodegib 150mg. In this case we introduce a patient whit cancer of upper lip of preoperative target therapy whit Vismodegib 150mg, which destroy the tumour cells and help us to make cosmetic surgical excision